Healthcare Provider Details

I. General information

NPI: 1346606985
Provider Name (Legal Business Name): JOHN VITUG PHD, LBA, BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BRICK BLVD STE 120
BRICK NJ
08723-7984
US

IV. Provider business mailing address

74 BRICK BLVD STE 120
BRICK NJ
08723-7984
US

V. Phone/Fax

Practice location:
  • Phone: 973-298-0763
  • Fax: 833-538-0904
Mailing address:
  • Phone: 973-298-0763
  • Fax: 833-538-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: